Hennrick Heather, Miller Elizabeth, Lai Wyman W, Nelkin Viannae Carmona, Flores Ana-Mercedes, Olson Marissa, Kong Dianne, Tan Alexander
Department of Psychology and Neuropsychology, Children's Hospital of Orange County, 1120 West La Veta Avenue, Suite 470, Orange, CA, 92868, USA.
Heart Institute, Children's Hospital of Orange County, Orange, CA, USA.
Pediatr Cardiol. 2024 Apr;45(4):821-828. doi: 10.1007/s00246-024-03425-9. Epub 2024 Feb 28.
Differences in surveillance methods have resulted in significant variability in referral volumes and referral completion rates across cardiac neurodevelopmental programs, with frequent barriers to referral completion including high no-show rates, lack of education, and inaccessibility for underrepresented populations. The purpose of this study was to describe implementation of a standardized surveillance program and investigate impact on referral volume and completion over a two-year period. Between fiscal years 2021 and 2022, a surveillance program was implemented which standardized assessment of neurodevelopmental risk via a checklist as well as family education and referral procedures. All patients referred to the cardiac neurodevelopmental program during these two fiscal years were included in the analysis, and patient referrals were categorized as complete or incomplete (due to physician-related or patient-related factors). Referral completion rates between fiscal years were compared using two sample Z test of proportions, while associations between referral completion and demographic/anatomical variables were completed using chi-square tests of independence. Implementation of the formal surveillance program resulted in a 66.7% increase in referral volume. Proportions of both incomplete referrals (z = 2.00, p < 0.05) and incomplete referrals due to physician-related factors (z = 4.34, p < 0.01) were significantly lower after implementation. A significant association was found after implementation between referral completion and race/ethnicity (x = 14.08, p < 0.01) due to a significantly high proportion of completed referrals for patients identifying as Hispanic/Latino within the overall distribution of patients. This study describes the successful implementation of a standardized surveillance program, including improvements to referral volume and completion rate. Findings also support implementation of methods that emphasize physician surveillance methods and improve accessibility for historically marginalized groups at greatest risk for disparities in access and quality of care.
监测方法的差异导致各心脏神经发育项目的转诊量和转诊完成率存在显著差异，转诊完成经常面临障碍，包括高失约率、缺乏教育以及弱势群体难以获得服务。本研究的目的是描述标准化监测项目的实施情况，并调查其在两年期间对转诊量和完成率的影响。在2021财年至2022财年期间，实施了一项监测项目，该项目通过一份清单以及家庭教育和转诊程序对神经发育风险进行标准化评估。这两个财年转诊至心脏神经发育项目的所有患者均纳入分析，患者转诊分为完成或未完成（由于医生相关或患者相关因素）。使用两样本Z比例检验比较财年之间的转诊完成率，同时使用独立性卡方检验完成转诊完成与人口统计学/解剖学变量之间的关联分析。正式监测项目的实施使转诊量增加了66.7%。实施后，未完成转诊的比例（z = 2.00，p < 0.05）和因医生相关因素导致的未完成转诊比例（z = 4.34，p < 0.01）均显著降低。实施后发现转诊完成与种族/民族之间存在显著关联（x = 14.08，p < 0.01），因为在患者总体分布中，自认为是西班牙裔/拉丁裔的患者完成转诊的比例显著较高。本研究描述了标准化监测项目的成功实施，包括转诊量和完成率的提高。研究结果还支持实施强调医生监测方法的措施，并改善历史上处于边缘地位、在获得医疗服务和医疗质量方面差异风险最大的群体的可及性。
